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Name
Gender
What is your maritial status?
Date of birth
What is your income(THB)?
Do you have a home loan?
What is the estimated value of your home(THB)?
Do you have a life insurance?
Do you have a car?
Do you have health insurance?
Do you have a credit card?
Phone number
E-mail
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Please ensure that you understand details of policy and coverage before making any purchase.